[The quality of the survey-questionnaire Danish National Survey of Patient Experiences is questionable]. / Den Landsdækkende Undersøgelse af Patientoplevelser har tvivlsom kvalitet.

We question the social science methodology in survey-questionnaire Danish National Survey of Patient Experiences (LUP). The results from the survey are part of the accreditation system in The Danish Health-care Quality Programme (DDKM). The methodological validity is researched through LUP-publications. We find that LUP has doubtful scientific quality which means that the validity of the survey results as such is questionable. Since this has consequences for the practical, economic, political and health-care decisions, we recommend that the total accreditation programme should be reconsidered.

[Improved questionnaire concerning the Danish National Survey of Patient Experiences]. / Forbedring af spørgeskema vedrørende Den Landsdækkende Undersøgelse af Patientoplevelser.

We question the evaluation-design of the Danish National Survey of Patient Experiences (LUP). The results from the survey are part of the accreditation system in The Danish Health-care Quality Programme. How the evaluation-design may be improved is researched through a revised questionnaire tested during a three-month period. We find that the existing evaluation-model must be replaced by a developmental evaluation-approach/model which includes valid measures of patient-satisfaction, other target-groups, and allows for the context of the specific health-care sector.

Effect of nutritional support on clinical outcome in patients at nutritional risk.

BACKGROUND & AIMS: Undernourished patients have an increased risk of complications and a prolonged hospital stay, compared to those who are not undernourished. The aim of this study was to evaluate the effect of nutritional intervention in a random sample of hospitalized patients at nutritional risk. METHODS: A randomized, controlled trial of nutritional intervention in 212 patients. Intervention consisted of a specialized nutritional team (nurse and dietician) who attended patients and staff for motivation, detailed a nutritional plan, assured delivery of prescribed food and gave advice on enteral or parenteral nutrition when appropriate. The control group received the standard regime used in the department. The primary endpoint was the part of the length of stay (LOS) that was considered to be sensitive to nutritional support, designated LOSNDI. The nutritional discharge index (NDI) consists of three objective criteria: (1) the patient is able to manage toilet visits without assistance, reflecting mobilization; (2) the patient is without fever (tp < 38 degrees C), reflecting absence of infection; and (3) the patient has no intravenous access, reflecting absence of complications in general. On the day when all three criteria were fulfilled, hospital stay was no longer considered to be sensitive to nutritional support. Actual LOS is also reported. Incidence and severity of complications were recorded to explain LOSNDI findings. As a secondary endpoint, quality of life was evaluated by the Short Form 36 (SF-36) questionnaire. RESULTS: Intervention led to an intake of > or = 75% of requirements in 62% of the intervention patients, as compared to 36% of the control patients. Rates of complications, mean LOSNDI and LOS were not significantly different between the two study groups. However, among patients with complications a difference in LOSNDI between intervention patients (14 +/- 2 days, mean +/- SE) and control patients (20 +/- 2 days) was statistically significant (P = 0.015). In the same patients, LOS was 17 +/- 2 days in the intervention group and 22 +/- 2 days in the control group (P = 0.028). The SF-36 questionnaire did not show a significant effect of treatment. CONCLUSIONS: Protein and energy intake of nutritionally at-risk patients was increased which resulted in shortening of the part of the length of stay that was considered to be sensitive to nutritional support (LOSNDI) and shorter length of stay (LOS) among patients with complications.